Contents Chapter Topic Page Neonatology Respiratory Cardiology

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Dose in mmol of NaHCO3 = Base deficit (mmol/L) x Body weight (kg) x 0.4 6. The underlying cause of acidosis must be sought and treated. For e.g. if the cause is hypotension the primary treatment is to correct the basic problem and alkali is the adjunct 7. For metabolic alkalosis treatment is that of the underlying condition G. Treatment of respiratory acidosis and alkalosis 1. A steadily rising PCO2 at any stage in the disease is an indication that ventilatory assistance is likely to be needed 2. A sudden rise may be an indication of acute changes in the infant’s condition e.g. pneumothorax, collapsed lobes, misplaced endotracheal tube 3. A swift rise in PaCO2 often accompanied by hypoxia following weaning is often an indication that the infant is not ready. 4. A gradual rise in PaCO2 at the end of the first week in a LBW infant on ventilator may be an indicator of the presence of a patent ductus arteriosus 5. In a child on ventilator, low PaCO2 means the child is likely to be overventilated, hence treatment is to wean down the ventilation. However in some conditions like persistent hypertension or cerebral oedema a slightly low PaCO2 may be necessary in the treatment. H. Examples of Arterial Blood Gas (ABG) Interpretation 1. A 20 weeks’ gestation and 1.1 kg BW infant has RDS. He is 20 hours old and is being nursed on nasal CPAP. His ABG shows: pH 7.21 PaCO2 6.6 kpa PaO2 7.5 kpa HCO3 - 20 mmol/L BE -4 mmol/L Question (Q) : What does the ABG show? Answer (A) : Mild respiratory acidosis due to worsening RDS Q: What is the next appropriate mode of therapy? A : Mechanical ventilation 2. Below is the ABG of a 10 hour old 28 weeks’ gestation infant pH 7.22 PaCO2 7 kpa PaO2 10 kpa HCO3 - 17 mmol/L BE -8 mmol/L Q. What does the ABG show A. Mixed respiratory and metabolic acidosis
Q. Name a likely diagnosis A. RDS 3. The following is the ABG of a 40 day old 26 weeks’ gestation baby pH 7.38 PaCO2 8 kpa PaO2 8 kpa HCO3 - 35 mmol/L BE +10 mmol/L Q. What does the ABG show? A. Fully compensated respiratory acidosis by metabolic alkalosis Q, What is a likely diagnosis? A. Chronic lung disease 4. An infant of 30 weeks’ gestation and BW 1.3 kg is being ventilated . ABG shows: pH 7.35 PaCO2 3 kpa PaO2 15 kpa HCO3 - 12 mmol/L BE -12 mmol/L Q. Interpret the ABG A. Fully compensated metabolic acidosis by respiratory alkalosis and hyperoxaemia Q What is your next course of action? A. Reduce FiO2, administer a small dose of NaHCO3, treat any other contributory cause of acidosis and wean down ventilation setting 5. A term infant is being ventilated for meconium aspiration. His ABG is as follows : pH 7.16 PaCO2 10 kpa PaO2 6 kpa HCO3 - 16 mmol/L BE -10 mmol/L Q. What is likely to have happened? A. Pneumothorax Q. What is your interpretation of the ABG A. Mixed respiratory and metabolic acidosis with hypoxaemia
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Contents Chapter Topic Page 1 Norma
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Dermatology 67 Atopic Dermatitis…
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Dato’ Dr. Lim Nyok Ling Consultan
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ISSN 1823-3856 Printed by: Perniaga
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Foreword One of the maxims of scien
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B. Anthropometric Measurements a) H
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Immunisation 1. Immunisation schedu
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2 General Notes 2.1 Many vaccines (
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3.5.6 Rubella - Contraindicated in
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4.8 Rubella May have rash, fever,
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5.5 Close contacts of immuno-defici
Page 23 and 24: Developmental Assessment Developmen
Page 25 and 26: Hearing Assessment Warning signs fo
Page 27 and 28: Global Developmental Delay History
Page 29 and 30: Developmental Milestones Table AGE
Page 31 and 32: AGE Gross Motor Vision & Fine Motor
Page 33 and 34: Principles of Transport of the Sick
Page 35 and 36: 3.1 Airway Management Establish a p
Page 37 and 38: 3.7 Environment Neutral Thermal Env
Page 39 and 40: 7. Special Surgical Conditions 7.1
Page 41 and 42: • Ventilation - Most of the babie
Page 43 and 44: Neonatal Resuscitation High Risk De
Page 45 and 46: • Drugs are available (and prepar
Page 47 and 48: Meconium stained liquor: Meconium i
Page 49 and 50: Summary: Use of medications during
Page 51 and 52: Definition Premature infant: < 37 w
Page 53 and 54: 8. Supplements: a. At birth : Vitam
Page 55 and 56: Enteral Feeding in Neonates 1. Intr
Page 57 and 58: 32 weeks Well babies Start milk imm
Page 59 and 60: Total Parenteral Nutrition for Neon
Page 61 and 62: Clearance is usually monitored by m
Page 63 and 64: Daily weight Meticulous care of th
Page 65 and 66: Monitor BUSE and correct any imbala
Page 67 and 68: C. UAC and UVC care UAC position Le
Page 69 and 70: HIGH FREQUENCY OSCILLATORY VENTILAT
Page 71 and 72: 6. Infants must be monitored closel
Page 73: pH , PaCO2, PaO2, HCO3 - , Bases Ex
Page 77 and 78: A. Definition Birth Asphyxia There
Page 79 and 80: E. Management I. Good intrapartum c
Page 81 and 82: c. All doctors managing such infant
Page 83 and 84: Etiology Determination of etiology
Page 85 and 86: FLOW CHART: MANAGEMENT OF NEONATAL
Page 87 and 88: 2. Klauss & Fanaroff: Care of The H
Page 89 and 90: D. Asymptomatic Hypoglycaemia Feed
Page 91 and 92: NEONATAL JAUNDICE What is jaundice?
Page 93 and 94: Physical examination • General co
Page 95 and 96: Once the baby is on phototherapy, v
Page 97 and 98: Reference: extracted from MOH publi
Page 99 and 100: - 1ml of 4.2% NaHCO3 given for ever
Page 101 and 102: a. If unconjugated hyperbilirubinae
Page 103 and 104: APNOEA IN THE NEWBORN Definition :
Page 105 and 106: History NEONATAL SEPSIS Septic Neon
Page 107: Antibiotic choice will depend on pr
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Contents Chapter Topic Page Neonatology Respiratory Cardiology

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